Tuesday, April 17, 2007

The cost of Health

On RTE’s Morning Ireland today it was pointed out that the basic salary in the proposed new consultant contract, reported to be €205,000 plus up to 20% performance-related annual bonus, is 50% higher than the basic salary for consultants in the UK NHS, a figure that was not disputed by the IHCA representative.

However, later this morning the talks between HSE and the IHCA have broken down, with the IHCA reported by RTE as describing the contract and money of offer as “Mickey Mouse”.

Some weeks ago, RTE’s Fergal Bowers, an authoritative source on medical industrial relations, opined that existing consultants would be looking for a salary of nearer to €400k in order to agree the pay element of a new contract. The IHCA response today suggests that Mr Bowers is probably not too far off the mark.

The justification offered by spokesmen for the medical organisations for such very high salary levels, relative to UK peers, is that we want to attract and retain the best possible medical practitioners.

Are we, the ultimate paymasters of the consultants, expected to believe that the Irish consultants are superior in quality to their British counterparts? There might be 5% - 10% who genuinely are, but the vast majority will be no better or no worse than the average in UK or any other European health service.

The IHCA and the IMO are now undertaking a proactive campaign to discourage doctors in Ireland and abroad from applying for any of the new consultant posts, due to be advertised later this week.

Such activity should be classified as industrial action by these organisations on behalf of their members. Any refusal by existing consultants to cooperate with the new recruits should be used treated as a breach of existing contract and used as grounds for dismissal.

The reality is that we should be better off if we could shed the existing expensive consultants and replace them with a new, more flexible and affordable workforce.

Think of it this way: Every €10m in annual salary cost probably gets you 25 existing consultants but would pay for 50 new ones. The system will lose some experience and expertise in shedding the existing lot, leading to some sub-optimal outcomes from patients who are currently at the top of the queue. However, doubling the number of consultants, for the same money, means that the outcomes for a huge number of patients further down the queue will be significantly better.

Put simply, we could afford to employ many more consultants and the resulting reduction in waiting times means that patients will be seen much sooner and this early intervention must greatly increase the prospects for those currently waiting months or years to see a consultant. Naturally, this would have to be done as part of a much wider reform of the hospital service.